Acute lower limb ischemia

Author: Karolina Steinerová, MD, Assoc. Prof. Petr Štourač, MD, Ph.D., Kateřina Matoušková, Peter Minárik

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: aterosclerosis | ischemie | klaudikace

Educational evel: Undergraduate level | Graduate

Acute lower limb ischemia is a serious disease with high morbidity and mortality if left untreated. There are about 150 cases of this disease on 1 million inhabitants per year. It is sudden disease that can lead to an amputation of a limb because of low blood flow and perfusion of the tissues. There are two basic causes of this disease. It is embolisation into the arteries of the limbs and in-situ thrombosis on a plaque of atherosclerosis. Correct diagnosis and early started therapy influence prognosis of the patients. You can solve a diagnosis, treatment, complications and following therapy in our algorithm.

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The algorithm Acute lower limb ischaemia is really distinctive. This disease is really frequent and the incidence is about 14-15/ 100 000 inhabitants. Muscular  toleration of  ischaemia is appoximately 3 hours  and that is why we have to think about  this diagnosis and start to solve it during the transpost  into the hospital as we can see in this algorithm. In practice we can see 2 most frequent mistakes. The first one is that every patient with sudden pain of the lower limb is transported to the specialized vascular surgery as an acute limb ischaemia without an examination of the pulsation. Peripheral pulsation exclude an acute ischaemia, but chronical peripheral arterial disease is possible.  Good thing is that there is no delay, because acute lower limb ischaemia requires the fastest diagnosis and treatment of all of the possible causes of a limb pain. However the examination on the vascular surgery is uselessly urgent. The second mistake is diagnosing vein thrombosis and the patient comes with the vein and not the arterial examination. In this algorithm the case is really practical. This algorithm describes how it should be but not real practice. The worth thing of this algorithm is that it shows the treatment of acute limb ischaemia means only the beginning of the patient's care- we have to do next examinations to find out the cause of the ischaemia, controls and set up the efficient therapy (atrial fibrilation or other dysrrhytmia, atherosclerosis , antioedematous therapy if there is an indication of fasciothomy).

publikováno: 27. 4. 2016 | last modified on: 13. 9. 2019